Older women with type 2 diabetes have an increased risk of nonspine fractures. The higher risk of falling associated with diabetes partially accounts for this increased risk. Current evidence suggests that there may also be impairments of bone strength in type 2 diabetes that are not well captured by bone mineral density testing. There is limited observational evidence that poor glycemic control and the associated complications of peripheral neuropathy and retinopathy may increase fractures, falls, and bone loss. However, this hypothesis has not been tested in a randomized trial. It remains to be elucidated whether treating diabetes and diabetic complications aggressively can alter skeletal health either directly or by preventing diabetic complications that contribute to falls and fractures. Health care professionals should be aware of the increased fracture risk among older women with diabetes and should ensure screening, treatment, and fall prevention strategies are appropriately implemented.